This form can be printed and filled out if electronic submission is not preferred. Please fax the form to Karen Gregor, at (216) 368-0409.

Requestor/Sponsor:_____________________________________________________

Department:___________________________________________________________

Building & Location Code:_______________________________________________

Campus Phone Number:__________________ Fax Number:________________

Date of Event:__________________________

Name of Event:________________________________________________________

Location (Choose One):

Visitor Information Center Lot________ Other (Specify)_____________________

If a security presence is needed at 2 locations for the same event, separate request forms must be completed.

Time Period for Coverage: From__________ To___________

Money Collected: Yes___________ No___________

Alcohol Served: Yes___________ No___________

Number of People Attending:______________

Number of Security Officers Needed:_______

Account Number to Charge:_______________________________________

Special Instructions:_______________________________________________________
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